scholarly journals Stenting versus non-stenting following uncomplicated ureteroscopic lithotripsy: Comparsion and evaluation of symptoms

2016 ◽  
Vol 73 (9) ◽  
pp. 850-856
Author(s):  
Slavisa Savic ◽  
Vinka Vukotic ◽  
Miodrag Lazic ◽  
Natasa Savic
Keyword(s):  
Stent Placement ◽  
Ureteral Stent ◽  
Successful Outcome ◽  
Ureteral Stones ◽  
Ureteroscopic Lithotripsy ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Pain Visual Analog Scale ◽  
Stented Group ◽  
Free Rate

Background/Aim. Currently, ureterorenoscopic (URS) stone fragmentation and removal is the treatment of choice for managing ureteral stones, especially mid and distal ones and is advocated as initial management of ureteric stones. The aim of this work was to evaluate the symptoms, necessity, potential benefits and adverse effects of ureteral stent placement after uncomplicated ureteroscopic lithotripsy. Methods. This retrospective-prospective study evaluated a total of 125 patients who had underwent ureteroscopic lithotripsy (URSL). The patients were divided into two groups: stented (59 patients) and unstented (controls, 66 patients). The outcomes measured and compared between the two groups included: stone free rate, postoperative patient pain validated by scale, lower urinary tract symptoms (LUTS), the need for unplanned hospital care, stent related complications, and functional recovery in the form return to normal physical activities. Results. A successful outcome, defined as being stonefree after 12 weeks, was achieved in all 125 (100%) patients. The stone-free rate showed no significant differences between the two groups. LUTS was frequent complaint in the stented group, with statistically significant difference in the domain of frequency/urgency (p = 0.0314). There was a statistically significant difference between the groups in the mean operative time and mean hospitalization time, mean pain visual analog scale (VAS) score and in the use of nonnarcotic analgesic. On the day of the surgery and until postoperative day 3 (POD 3) and postoperative day 5 (POD 5), the pain score was much higher among stented patients than among the controls (p = 0.0001) and non-narcotic analgesic use (p = 0.001) was frequently required in the stented group. Conclusion. Routine placement of ureteral stent after URSL is not mandatory and may be associated with stent side effects. Uncomplicated URSL is safe without stent placement after the treatment.

scholarly journals Retrograde versus Antegrade Approach for the Management of Large Proximal Ureteral Stones

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Stavros Sfoungaristos ◽  
Ioannis Mykoniatis ◽  
Ayman Isid ◽  
Ofer N. Gofrit ◽  
Shilo Rosenberg ◽  
...  
Keyword(s):  
Operative Time ◽  
Fluoroscopy Time ◽  
Ureteral Stones ◽  
Ureteroscopic Lithotripsy ◽  
Antegrade Approach ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Stone Characteristics ◽  
Length Of Hospitalization ◽  
Free Rate

Objective. To evaluate and compare the efficacy and safety of retrograde versus antegrade ureteroscopic lithotripsy for the treatment of large proximal ureteral stones.Patients and Methods. We retrospectively analyzed the medical records of patients with proximal ureteral stones >15 mm, treated in our institution from January 2011 to January 2016. Intraoperative parameters, postoperative outcomes, and complications were recorded and compared between the two techniques.Results. Our analysis included 57 patients. Thirty-four patients (59.6%) underwent retrograde and 23 patients (40.4%) underwent antegrade ureteroscopy. There was no significant difference in patients’ demographics and stone characteristics between the groups. Stone-free rate was significantly higher (p=0.033) in the antegrade group (100%) compared to retrograde one (82.4%). Fluoroscopy time, procedure duration, and length of hospitalization were significantly (p<0.001) lower in retrograde approach. On the other hand, the need for postoperative stenting was significantly lower in the antegrade group (p<0.001). No difference was found between the groups (p=0.745) regarding postoperative complications.Conclusions. Antegrade ureteroscopy is an efficient and safe option for the management of large proximal ureteral stones. It may achieve high stone-free rates compared to retrograde ureteroscopy with the drawback of longer operative time, fluoroscopy time, and length of hospitalization.

The Outcomes of Pre-Stenting on Renal and Ureteral Stones: A Meta-Analysis

2021 ◽  
pp. 1-9
Author(s):  
Han Chen ◽  
Yang Pan ◽  
Min Xiao ◽  
Jingruo Yang ◽  
Yong Wei
Keyword(s):  
Operative Time ◽  
Meta Analysis ◽  
Renal Stones ◽  
Flexible Ureteroscopy ◽  
Ureteral Stones ◽  
Ureteroscopic Lithotripsy ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Meta Analyses ◽  
Free Rate

<b><i>Background:</i></b> Pre-stenting (PS) on the outcomes of semirigid and flexible ureteroscopic lithotripsy for a different upper urinary urolithiasis remains controversial. We performed a meta-analysis comparing the outcomes of ureteroscopic lithotripsy between PS and non-PS. <b><i>Materials and Methods:</i></b> Randomized, controlled trials and observational studies comparing PS and non-PS were identified from electronic databases. Stone-free rate (SFR), operative time, and complications were compared by qualitative and quantitative syntheses (meta-analyses). <b><i>Results:</i></b> Eleven articles were included in this study. Nearly, all of recently published studies exhibited relatively moderate or high quality during quality assessment. PS was more likely to achieve good SFR compared with non-PS (<i>p</i> &#x3c; 0.00001). The subgroup results indicated that PS improved the SFR for renal stones and the stones dealt by flexible ureteroscopy (<i>p</i> = 0.0002; <i>p</i> &#x3c; 0.0001, respectively; some ureteral stones were dealt by flexible ureteroscopy). Ureteral stones and the stones dealt by semirigid ureteroscopy were not influenced by PS (<i>p</i> = 0.62; <i>p</i> = 0.90, respectively). PS is equal as non-PS in terms of operative time for renal stones and the renal and ureteral stones dealt by flexible ureteroscopy (<i>p</i> = 0.47; <i>p</i> = 0.05). No significant difference was found in major complications between the 2 groups for total or for the subgroup of renal stones (<i>p</i> = 0.3; <i>p</i> = 0.69). <b><i>Conclusions:</i></b> For ureteral stones or the stones dealt by semirigid ureteroscopy, PS does not show any benefits. For renal stones or the stones dealt by flexible ureteroscopy, PS improves the SFR and may be as safe as non-PS.

scholarly journals EFFICACY AND SAFETY OF LUBRICATING JELLY INSTILLATION TO PREVENT RETROPULSION DURING URETEROLITHOTRIPSY FOR URETERAL STONES

2017 ◽  
Vol 24 (2) ◽  
Author(s):  
Rameshdo Yuanda ◽  
Doddy M Soebadi ◽  
Soetojo Soetojo ◽  
Sunaryo Hardjowijoto
Keyword(s):  
Ureteral Stones ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Efficacy And Safety ◽  
Ureteral Catheter ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Enhanced Computed Tomography ◽  
And Control ◽  
Free Rate

Objective: We studied the efficacy and safety of lubricating jelly instillation before ureterolithotripsy for prevention of retropulsion and improvement in stone-free rate. Material & methods: We enrolled 22 subjects with ureteral stone in this prospective, randomized, single-blind and controlled clinical trial. Each subject was randomly assigned to the lubricating jelly instillation group (n=11) and control group (n=11). Ureteroscopy and lithotripsy was performed according the standard protocol, using 9.8 F semirigid ureteroscope and pneumatic lithotripter. A 6 F ureteral catheter was advanced beyond the stone, and lubricating jelly was instilled through the catheter lumen. Retropulsion and the presence of residual fragments were evaluated with plain kidneys, ureters and bladder x-ray and ultrasonography, or Non Contrast-enhanced Computed Tomography. Any complication was reported and graded using the Modified Clavien Classification System.Results: The 2 groups had comparable preoperative characteristics. There were no statistically significant difference between the lubricating jelly instillation group and control group regarding the retropulsion rate (54.5% vs 72.7%, ρ=0.375), the stone-free rate (54.5% vs 36.4%, ρ=0.392), and the complication rate (45.5% vs 54.5%, ρ=0.670). Conclusion: Lubricating jelly instillation during ureterolithotripsy has limited value for prevention of retropulsion and improvement in stone-free rate.

scholarly journals USAGE OF SUPPORTING PAD FOR SUPINE PCNL: A SINGLE CENTER EXPERIENCE

2022 ◽  
Vol 29 (1) ◽  
Author(s):  
Rizky Lukman Hakim ◽  
Ponco Birowo
Keyword(s):  
Pediatric Patients ◽  
Renal Stones ◽  
Ureteral Stones ◽  
Inclusion Criteria ◽  
Single Center Experience ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Effective Choice ◽  
A Prospective Study ◽  
Free Rate

Objective: This study aims to compare the safety, efficacy, and other surgical outcomes of supine PCNLs performed with and without the use of supporting pad. Material & Methods: We enrolled 27 patients who undergone PCNL procedure with supine position for renal stones with all sizes between January - December 2019. Divided into two groups, operated with and without supporting pad, with 13 and 14 patients respectively. Inclusion criteria are patients with renal stones, including staghorn, multiple calyx, and proximal ureteral stones. Meanwhile, pediatric patients under 12 years old, uncorrectable bleeding disorders, active urinary infection, and pregnancy are excluded. Results: Our observation showed no statistically significant difference between the two groups, although blood loss and length of stay in supporting pad showed better results. A statistically significant difference was found in stone-free-rate (P = 0.006) favoring in supine PCNL with supporting pad. Conclusion: Supine PCNL with support padding may be a safe and more effective choice to treat renal stones. Nevertheless, the patient’s anatomic variations may influence this. Thus, a prospective study with a larger population is needed to verify our outcomes.

scholarly journals A Retrospective Analysis of Effect of Hounsfield Unit of Ureteric Calculus on Outcome of Ureteroscopic Lithotripsy

2021 ◽  
Vol 8 (12) ◽  
pp. 662-666
Author(s):  
Jayaprakasha Gangadharaiah ◽  
Imdad Ali N ◽  
Paresh Sankhe
Keyword(s):  
Hounsfield Unit ◽  
Renal Calculus ◽  
P Value ◽  
Ureteroscopic Lithotripsy ◽  
Ureteric Calculus ◽  
Extracorporeal Shock Wave ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Stone Migration ◽  
Free Rate

BACKGROUND This study was conducted to check whether computer tomography (CT) parameter Hounsfield Unit has any bearing on outcome of ureteroscopic pneumatic lithotripsy and as to whether it can predict success rate of ureteroscopic lithotripsy in the management of ureteric calculus. CT Hounsfield Unit tells us about hardness of stone, and it is primarily important in non-invasive management of ureteric and renal calculus such as extracorporeal shock wave lithotripsy (ESWL). METHODS We retrospectively reviewed records of 420 patients who underwent URSL from January 2016 to January 2020. A total of 186 patients of ureteric calculus did undergo CT in pre-operative evaluation for stone. Data of those patients was taken for study. Intra op clearance of calculus was decided by ureteroscopy finding on the table. All complications and difficulties of the procedure were documented. RESULTS We analysed the correlation between the outcome of the URSL and Hounsfield unit in finding the position of the stone and size of the stone. Out of 186 study participants, 111 (59.6 %) patients needed a single procedure for stone clearance whereas 75 (40.4 %) needed multiple procedures for clearance. Out of 186, 22 had HU < 500, 112 had HU 501 - 1000, 52 had HU > 1000. The majority of patients had HU between 501 - 1000HU. Complete clearance was seen in 63.6 % of < 500 HU patients, 62.5 % of 501 - 1000 HU patients and 55.7 % of > 1000 HU patients. This difference in clearance was statistically not significant. Similarly, the rate of complication when compared among the three groups doesn’t show a statistically significant difference (P value 0.293). The requirement of repeat procedure was maximum in > 1000 HU patients but the difference between the three groups was not statistically significant. Stone migration rate was found to be more in > 1000 HU stones (80.76 %) and this was statistically significant. CONCLUSIONS To conclude CT Hounsfield Unit’s utility in predicting the stone-free rate and complication rate doesn’t show significant bearing in patient undergoing URSL procedure. KEYWORDS CT, Hounsfield Unit, URSL, Stone Free Rate, Stone Density, Complication

The clinical efficacy of novel vacuum suction ureteroscopic lithotripsy in the treatment of upper ureteral calculi

2021 ◽  
Author(s):  
LvWen zhang ◽  
Yan Song ◽  
Xiang Fei
Keyword(s):  
Clinical Efficacy ◽  
Subgroup Analysis ◽  
Ureteral Calculi ◽  
The Novel ◽  
Total Treatment Cost ◽  
Ureteroscopic Lithotripsy ◽  
Vacuum Suction ◽  
Stone Free Rate ◽  
Total Treatment ◽  
Free Rate

Abstract This study investigated the clinical efficacy of a novel vacuum suction ureteroscopic approach in the treatment of upper ureteral calculi. A total of 160 patients with impacted upper ureteral calculi were included in this study. 50 patients underwent rigid ureteroscopic lithotripsy, 54 patients underwent flexible ureteroscopic lithotripsy, and 56 patients underwent vacuum suction ureteroscopic lithotripsy. The operative time, length of hospitalization, stone-free rate, complication rate and total treatment cost were compared among the three groups. Subgroup analysis was performed based on the stone diameter over and below 1.5 cm. Compared with the other two groups, the vacuum suction ureteroscopy group had higher stone-free rate at 3–5 days (90.0% vs. 61.9% vs. 55.6%, P < 0.05) and 1 month (96.4% vs. 77.7% vs. 74.0%, P < 0.05) postoperatively. In subgroup analysis, the stone-free rate of the vacuum suction ureteroscopy group was significantly higher when the stone diameter was > 1.5 cm at 1 month postoperatively ( P < 0.05); however, there were no differences in postoperative complications.( P > 0.05). In conclusion, the novel vacuum suction ureteroscopic lithotripsy has significantly improved the stone-free rate especially in complicated cases; however the complication and cost was not increased.

scholarly journals Extracorporeal Shock Wave Lithotripsy verus Rigid Ureteroscopy in Treatment of Mid-Ureteric Stones; Randomized Prospective Study

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A S Hegazy ◽  
M I Ahmed ◽  
A F M Abdelgawad
Keyword(s):  
Shock Wave ◽  
Urinary Tract ◽  
Prospective Study ◽  
Hospital Stay ◽  
Shock Wave Lithotripsy ◽  
Ureteral Stones ◽  
Extracorporeal Shock Wave ◽  
Stone Free Rate ◽  
Operative Complications ◽  
Free Rate

Abstract Background Urinary stone disease or nephrolithiasis, the third most common disease of the urinary tract is a major health problem due to its high prevalence, incidence and recurrence. The lifetime incidence of kidney stones for men and women is approximately 13% and 7% respectively. Although stones may be asymptomatic, potential consequences include abdominal and flank pain, nausea and vomiting, urinary tract obstruction, infection, and procedure-related morbidity. Ureteral stones frequently cause renal colic and if left untreated can cause obstructive uropathy. Objectives A prospective randomized study to compare between extracorporeal shock-wave lithotripsy and rigid ureteroscopy in mid-ureteric stone treatment regarding efficacy, stone-free rate, retreatment rates, associated complications (intra-operative and post-operative), operative duration, hospital stay. Patients and Methods This study was performed at Ain Shams University (Urology department) and El Doaah hospital (Urology department), From August 2016 to August 2017, a total of 50 patients having solitary radiopaque middle ureteral stone ranges between 0.5 – 1.5 in size were divided into two groups 25 patients each enrolled in our prospective study. Results In this study the overall stone free rate was considered after two sessions of ESWL (in case of ESWL group) or one trial of ureteroscopy (in case of URS group). ESWL group: 14 cases became stone free after the first session, while the remaining 11 out of 25 patients needed second session, 6 cases became stone free after the second session. ESWL failure occurred in 5 cases and they were successfully managed by ureteroscopy. URS group: 23 cases became stone free after first ureteroscopy, while the remaining 2 patients needed second ureteroscopy due to proximal migration of the stone. In ESWL group, patients were already at outpatient clinic so there were no admission or hospital stay, all cases done without anesthesia, just analgesic ± sedation. While in URS group patients admitted and the hospital stay varies from one day to seven days according to the condition of the case, all URS cases had Spinal anesthesia. ESWL was shown to be less time consuming than URS with a mean operative time of 46.84±3.61 minutes versus 56.20±7.11 minutes respectively. In URS group there were 22 patients had ureteric catheter inserted for 24 to 72 hours postoperatively and 3 patients had double (J) stent inserted for 4 weeks postoperatively, while all the patients who underwent ESWL, no auxiliary procedure done as this procedure is completely non-invasive. Among ESWL cases, No case had an intra-operative complication, while URS group had 3 cases of intra-operative complication. There were 4 cases who had post-operative complications among ESWL group, while there were 5 cases who had post-operative complications among URS group. Conclusion In treatment of mid-ureteral stones range 0.5-1.5 in size, both URS and ESWL modalities are comparable but URS is recommended as a first option as it is more effective than ESWL regarding stone free rate and it provides immediate stone clearance with lower re-treatment rates and higher patient satisfaction, but URS requires anesthesia, longer hospitalization, and associated with a higher incidence of complications.

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